Help! My Cat is Urinating Blood

Crawford Dog and Cat Hospital

2135 Jericho Turnpike
Garden City Park, NY 11040



This wasn't going to be the topic for the day.  Honestly, I didn't have a topic for today but then I had two cats come in for urinary tract problems and I thought that it must be some sort of sign, so let's talk about cat urination.
One of the major attractions of cats as pets is that they don't need to be walked because they use a litter box for elimination.  When all goes well, they truck off to the little sand box in some out of the way place and all we have to do as owners is clean the box out periodically. Truth be told, we should do it every day, but we're all guilty of a little slip up now and then, just ask our cats.  I'm going to gloss over the behavioral problems that may cause cats to go to the bathroom out of the box, since that is a book's worth of information, and try to address the signs, symptoms, and possible causes of Feline Lower Urinary Tract Disease.(FLUTD).


Feline Lower Urinary Tract Disease is technically any disease process that affects the bladder and urethra.  This excludes the kidneys and ureters.  Originally characterized as an infection, we now know that there are a variety of diseases, some related, some not, but most causing similar signs in cats.

Signs and Symptoms

The clinical presentation of a cat with FLUTD is similar for most of the different causes of this disease, a fact that makes diagnosis a bit challenging.  Affected cats will have an increased frequency of urination, often going in and out of the box multiple times an hour but only urinating a small volume.  The decreased urine volume may have a stronger odor than normal and may have blood in it.  One emergency associated with this disease complex is urinary obstruction, much more common in male cats than females.  In obstructed, or blocked cats, the urethra is plugged with mucous, crystals, clots or small stones making it impossible for urine to pass.  This is a medical emergency and will be fatal if not treated. promptly. If your cat is in the box straining and little to no urine is coming out you must contact your veterinarian immediately.  Like now, not in the morning, not after work.

The tubes in the picture come from two cats that I saw in the office today.  The one on the right is concentrated so it is a little darker in color than one might expect.  The tube on the left is obviously bloody.  The cat that passed the bloody urine was actually passing clots as well.

Causes of FLUTD

When I graduated from Veterinary School, we were taught that all cats that were showing lower urinary tract signs had an infection and that the underlying cause was too much ash in the diet.  Diets were re formulated to change the mineral content (ash).  Then we were taught that it was an alkaline pH that caused the infections, so diets were re formulated to lower the pH.  Then we saw different problems emerging as the diets swung from one extreme to the other and the profession started to realize that most cases of FLUTD were not even infections.  In fact, in our practice, male cats that present with clinical signs of FLUTD rarely have an uncomplicated urinary tract infection.  So, what's the deal with FLUTD?  The following syndromes can cause the signs associated with FLUTD
  • Infection, or  infectious cysitis,  (the letters itis on the end of a word mean inflammation).  Usually caused by bacteria, this condition is more common in females than males.
  • Urinary Stones.  As the it would suggest, these cats have mineralized concretions in the bladder or urethra.  These stones irritate the bladder wall and cause the signs that we see.
  • Sterile cystitis.  Remember your lesson above, this is inflammation of the bladder without infection.
  • Urinary tract tumors.
  • Behavior.  I said I was going to skip this but I just put it here for completeness.


You veterinarian should take a careful history and then do an examination.  He or she may recommend diagnostic testing such as a urinalysis, a urine culture, radiographs or and ultrasound. Each test gives different information and helps to pin down the exact reason that your cat is having signs of FLUTD.


The treatment will depend on the cause of the clinical signs.  Infections are treated with antibiotics.  Stones may need to be removed surgically.  Sterile cystitis is managed with diet changes, stress management, and medication to control pain and inflammation.  It is particularly important to make sure that your cat continues to urinate while the diagnosis and treatment is on going.  If there is a problem passing urine, call your vet immediately.  Once a diagnosis is made, your veterinarian will work with you to set up a long term strategy to prevent re occurrence of this painful problem.


So, what can you do to help your cat avoid the painful FLUTD?  Across all studies, the most important thing seems to be to increase fluid intake.  Many of my colleagues in feline only practices recommend feeding only canned food due to the increased moisture content.  They feel that they see less FLUTD on cats that eat moist diets.  There is an increased risk of dental disease in cats eating only canned so some dry is probably a good idea.  Make sure that there is ample fresh water available.  Cats are notoriously poor drinkers so make the water as appealing as possible.  Drinking fountains, multiple clean bowls, dripping faucets, whatever it takes to encourage drinking.  And finally, stress reduction seems to help decrease the incidence of FLUTD.  So, alter your cat's environment to keep it interesting and stress free.  The Ohio State University, Indoor Pet Initiative is an excellent resource.
To paraphrase Fellinini, "To be fit as a fiddle, a man (cat) has to piddle."  "Something's amiss if a cat doesn't piss"